Profile

Menu Style

‘First Do No Harm’ the documentary film directed by James Reynolds aims a theatrical release in United States this year. The film explores the story behind the controversial and paternalistic history of blood transfusions. The film is produced by Asia Geographic, which is a niche entertainment company.

The movie unfolds as world renowned experts share the latest scientific evidence, debunking claims that blood always saves lives. Millions of patients are now in danger from previously unknown risks associated with blood transfusions; like the effects of DNA and Chromosome transfer.

This documentary will make a difference in telling the story the documentary utilizes a wide variety of resources including research interviews, reconstructions, archival footage, photographs, maps, diagrams and graphics. Blood transfusions enabled surgeons to routinely perform lifesaving procedures unimaginable prior to World War II in the context of relatively limited resuscitation options available then, and it undoubtedly saved many lives.

Scientific research behind ‘First Do No Harm’

Astonishingly blood transfusion as a therapy has never undergone the rigorous testing that all other pharmaceutical agents must submit to before they are approved for use. In the early 1970s renowned medical pioneers like Denton Cooley MD began questioning the vision of “give a unit of blood and save a life.” The worldwide AIDS epidemic cast a spotlight on blood transfusions in the 1980s, efforts to eliminate the unseen risks of transfusion intensified.

The movie tells the story behind the evolution of many transfusion misconceptions like the fallacious assumption that blood stored for transfusion delivers oxygen. Since the last century the assumption has been that the oxygen-carrying capacity of stored blood is conclusive; however, this theory is untested. New insights reveal that during storage numerous changes occur in red cells and their biological function is altered. This condition is referred to as the storage lesion. The increased rigidity of the red cell membrane, the low levels of 2,3 Diphosphoglycerate and nitric oxide simply mean oxygen delivery to cells is impaired. This may help explain why blood transfusions actually harm some recipients. Another study reports that patients receiving blood that was stored for over two weeks were 70% more likely to die within a year than those who received fresh blood (The New England Journal of Medicine, vol 358, p1229).

What do these new findings mean for advocates of transfusion medicine?

Millions of patients may now be in danger from previously unknown risks associated with blood transfusions; for example the effects of DNA and chromosome transfers. The article, 'Transfusion-associated microchimeris says: “Y chromosome-based assay, investigators from our group studied women who received a relatively large number of allogeneic [donor] cellular blood transfusions 7 out of the 10 trauma patients showed survival of donor leucocytes for more than 6 months post-transfusion. According to another study, 'Michrochimerism decades after transfusion among combat-injured US veterans from the Vietnam, Korean and World War II conflicts', Transfusion 2008; 48: 1609- 15, “Transfusion for combat-related injury can result in michrochimerism that lasts for 60 years, suggesting that it may involve permanent engraftment”.

“There was little evidence to corroborate that blood would improve patients' outcomes in the vast majority of clinical scenarios in which transfusions are currently routinely considered,” says Dr. Aryeh Shander, Clinical Professor of Anaesthesiology, and Medicine & Surgery at the Mount Sinai School of Medicine in New York, USA. When transfusion is indicated for symptomatic anaemia, consideration should be given to transfuse one unit versus two. The mantra is to reduce, reuse and recycle. Coupled with optimizing red blood cell counts before surgery, the patient in effect becomes his own blood bank.

Globally 95 million units of blood are transfused annually. In the United States, over 80,000 units of blood components are transfused every day. In that country the price of a single unit is $1,200. What is not factored into the cost equation are civil cases and out of court settlements paid to victims of transfusion mishaps.What happens if a natural disaster, or terrorist act destroys a hospital's blood bank?“The events in the 2004 Beslan school massacre were a great tragedy not only for Russia, but for the whole world also,” acknowledges Vitaly Slepushkin, Professor of Medicine, Vladikavkaz Medical Academy, Vladikavkaz, Russia, he concludes “blood transfusions were few, and the number of patients that died was very, very low. I take a legitimate pride in this achievement of mine and my colleagues.” The Department of Health of the Government of Western Australia is moving from behavior-based transfusion practice to patient blood management as a standard of care statewide between 2008 and 2012. Studies have demonstrated that a reduction in blood transfusions means a reduction in associated risks of postoperative infection, patient length of hospital stay and costs. Empowering doctors to advise and patients to decide - the movie rallies leaders in medicine to – above all, first, do no harm.